Transfusion strategies in postinjury coagulopathy

Coagulopathy represents one of the major challenges in the management of the severely injured patient. The present review will attempt to define the current 'optimal' transfusion strategies for the coagulopathic trauma patient and to assess potential weaknesses in the pertinent literature.

Existing limitations in the management of postinjury coagulopathy include the lack of a uniform definition of the entity, the lack of understanding the mechanisms, and the lack of accurate and rapid diagnostic tests. Rapid thromboelastography represents an improved diagnostic modality that allows 'point-of-care' testing of postinjury coagulopathy and monitoring of transfusion strategies. Ongoing controversies in the field include the optimal target blood pressure and the ideal threshold for blood component transfusions in the hospital. Furthermore, the concentration of plasma transfusions remains an ongoing debate.

Coagulopathy has a significant impact on survival after major trauma. Most recent publications in the field are of retrospective design, and thus do not allow definitive recommendations for clinical practice. Well designed prospective trials and improved basic research studies are required to improve this important aspect of trauma care.